BLISS 



*  *  *  *  *c*  *'  *  -  *  *  * 

An  inaugural  Dissertation 

on  Permanent  Strictures 

of  the  Urethra 

/n-fiC8  9-2^ 


Columbia  (Bmttttfftp 

intijeCttptflettigork 

College  of  3Pf)p£tctan*  anb  ^burgeons 
Htfcrarp 


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N     */  : 


AN 

INAUGURAL  DISSERTATION 

ON 

PERMANENT  STRICTURES 

OF  THE 

URETHRA: 

SUBMITTED  TO  THE   PUBLIC   EXAMINATION   OF  THE 

TRUSTEES  AND  PROFESSORS  OF  THE  COLLEGE 

OF  PHYSICIANS  AND  SURGEONS  IN  THE 

UNIVERSITY  OF  THE  STATE  OF 

NEW-YORK, 

SAMUEL  BARD,  M.  D.  President, 

FOR  THE  DEGREE  OF 

DOCTOR  OF  MEDICINE, 

ON  THE  1ST  DAT  OF  MAY,  l8lj. 


BY  JAMES  C.  BLISS, 

Licentiate  in  Medicine  and  Member  of  the  American  Mfculaftan  Society, 


TROY: 

PRINTED   BY   PARKER   AND  BUSS. 


April,  1 8 15. 


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a. 


TO 

SAMUEL  BORROWE,  M.  B, 

ONE  OF  THF  SURGEONS  OF  THE  NEW-YORK  HOSPITAL, 

Sir, 

Permit  me  to  dedicate  this  Dissertation  to 
you,  as  a  teftimony  of  my  refpect  for  your  diftin* 
guifhed  profeffional  character ;  as  well  as  my  regard 
for  you  as  a  Gentleman,  Friend,  and  Inftru&or. 

JAMES  C.  BLISS. 


f* 


TO 

DR.  ELY  BURRITT, 

THIS  THESIS  IS  INSCRIBED 
AS  A 

TRIBUTE  OF  GRATITUDE 

FOR  HIS  VALUABLE  INSTRUCTION  IN  THE   EARLY  PART 
OF  MY    EDUCATION, 

AS  WELL  AS  AN 

EXPRESSION  OF  ESTEEM 

FOR  HIS  PRIVATE  VIRTUES. 

JAMES  C.  BLISS, 


DISSERTATION 

ON  PERMANENT 

STRICTURE  OF  THE  URETHRA. 


INTRODUCTORY  REMARKS. 

LITTLE  was  known  with  regard  to  the  nature  ©f 
Stricture,  till  the  accurate  inveftigations  of  Mr.  John 
Hunter  were  made  public. 

This  gentleman  nut  only  gave  us  the  firft  accurate 
account  of  the  affection,  but  fuggefled  one  of  the  moft 
important  improvements  in  its  treatment.  The  bougie 
was  known^as  early  as  the  year  1535,  as  mentioned 
by  Alphonldus  Ferrus ;  but  it  does  not  appear  that  its 
ufe  was  generally  adopted  till  recommended  by  Daran* 
Even  as  late  as  the  year  1750,  Mr.  Hunter  informs  us, 
that  the  common  bougie  employed  in  the  firft  Hofpi- 
tals  in  London,  was  either  a  piece  of  lead  or  a  fmal! 
wax  candle. 

Mr.  Hunter  has  been  feconded  with  much  zeal  and 
Induftry,  by  his  kinfman,  Mr.  Home,  who  has  given 
to  the  world  one  of  the  moft  elaborate  and  at  the  fame 
time  the  beft  practical  treatife  on  the  difeafe,  which 
we  poffefs. 


a 

Few  difeafes  have  more  engaged  the  attention  of 
furgeons,  within  a  few  years,  than  the  one  now  the 
fubject  of  remark :  hence  we  have  been  furnifhed  with 
a  great  number  of  publications  on  Stricture,  poifefling 
various  degrees  of  merit. 

The  bold  manner  in  which  the  cauftic  was  firft  re- 
commended, gave  rife  to  fome  controverfy  among  fur- 
geons ;  and  although  much  ingenuity  has  been  dif- 
played  and  labour  expended,  yet  little  practical  advan- 
tage has  refulted  from  this  difcuffion. 

Although  we  muft  acknowledge  much  has  been 
written  recently  on  this  fubject,  deferving  little  consid- 
eration among  the  great  number  of  publications  which 
have  appeared,  yet  many  important  obfervations  have 
been  made,  and  valuable  inferences  drawn  well  entitled 
to  the  regard  of  the  iurgeon. 

Mr.  Charles  Bell  has  written  an  excellent  little  trea- 
tife  on  difeafes  of  the  Urethra ;  and  has  fuggefted 
fome  novel  ideas  with  regard  to  the  nature  of  Stric- 
ture and  its  treatment.  *v 

It  is  proper  here,  alfo,  to  mention  the  excellent  pa- 
thological obfervations  of  Mr.  Ramfden,  on  difeafes 
of  the  Teflicle,  as  connected  with  primary  affections 
of  the  Urethra,  in  which  are  developed  many  impor- 
tant  facts  which  had  before  eluded  the  obfervation  of 
furgeons. 

We  are  indebted  to  a  furgeon  of  our  own  country, 
Dr.  Phyfick,  of  Philadelphia,  for  the  propofed  method 
of  treating  Strictures,  under  certain  circumftances,  by 
the  ufe  of  a  cutting  inftrument :  a  mode  which  fhe 


9 

Doctor  himfelf  has  Jafijpi^fl^put  in  practice,  m  a 
number  of  inftances. 

Wifeman,  firfl  fuggefted  the  ufe  of  cauftic  in  the 
treatment  of  Stricture,  but  it  does  not  appear  that  it 
was  ever  employed  to  any  extent,  till  revived  by  Mr. 
Hunter,  who  is  juflly  entitled  to  the  credit  of  origin- 
ality, for  it  does  not  appear  that  at  the  time  he  pub^ 
lifhed  the  account  of  his  treatment  of  Stricture  by 
cauftic  that  he  was  acquainted  with  the  fad,  that  it 
had  before  been  propofed  by  Wifeman. 

The  introduction  of  cauftic  in  the  cure  of  Stricture, 
was  doubtlefs  one  of  the  greateft  improvements  ever 
made  in  the  treatment  of  this  formidable  difeafe,  and 
Mr.  Hunter  for  this,  as  well  as  other  improvements 
in  furgery,  is  juflly  entitled  to  the  character  of  a  ben^ 
efactor  of  mankind. 


B 


M<! 


DISSERTATION,  &c. 


I.  THE  Urethra  is  a  tube  extending  from  the  neck 
of  the  bladder  to  the  extremity  of  the  glans  penis,  and 
through  the  greater  part  of  its  courfe  runs  in  the  infe- 
rior part  of  the  penis.  It  ferves  the  purpofe  of  con- 
veying the  urine  from  the  bladder,  and  the  femen  to 
the  vagina  of  the  female. 

It  is  lined  by  a  mucous  membrane,  fimilar  in  ftruc- 
ture  to  the  mucous  membranes  lining  other  paffages 
of  the  body.  Its  fenfibility  is  exceedingly  acute,  and 
its  fympathies  extenfive  and  remarkable. 

This  membrane,  from  its  flructure  and  office,  ex- 
periences fudden  dilatations,  as  in  the  expulfion  of  the 
urine,  &c.  and  is  equally  liable  to  fall  into  a  collapfed 
ftate,  when  the  diftending  caufe  is  removed.  In  its 
collapfed  ftate,  like  the  membranes  lining  the  ftomach? 
bladder,  &c.  under  fimilar  circumftances,  it  falls  into 
folds,  which  project  into  the  canal. 

It  has  been  obferved,  under  certain  circumftances^ 
to  poffefs  the  power  of  contraction ;  this  power  is  re- 
markable in  inflammation  attendant  on  gonorrhea  vi~ 
rulenta,  in  which  difeafe,  in  fame  inftances.,  the  canal 


12 


is  fo  contracted  that  the  urine  pafies  in  a  very  fmail 
ftream  or  by  drops.  Every  furgeon  has  been  accuf- 
tomed  to  notice  the  firm  manner  in  which  the  bougie 
is  frequently  embraced,  when  an  attempt  is  made  to 
withdraw  it  after  its  introduction  into  the  urethra. 
The  ftream  of  urine,  likewife,  has  long  been  noticed 
to  be  contracted  when  the  acrimony  of  this  fluid  is  in- 
creafed  by  the  watery  parts  of  the  blood  being  dimpa- 
ted,  in  warm  feafons  and  in  warm  climates,  by  per- 
fpiration. 

From  thefe  fads  has  arifen  the  opinion,  that  the 
urethra  pofTefles  mufcularity.  This  opinion  was  par- 
ticularly advocated  by  Mr.  Hunter. 

It  has  been  urged,  that  its  mufcularity  is  evinced  by 
fpafms  occurring  in  Stricture  and  under  other  circum- 
fiances.  This  contraction,  however,  is  evidently  anal- 
ogous to  that  which  takes  place  in  other  membranes, 
when  acted  upon  by  a  proper  ftimulant. 

This  is  more  particularly  exemplified  in  the  con- 
traction of  the  fkin  ;  which,  in  ftructure,  is  more  near- 
ly allied  to  the  mucous  membranes,  than  to  any  other 
membranes  of  the  body. 

The  particular  form  of  Stricture,  has  been  mention- 
ed as  another  proof  of  the  exiflenceof  mufcular  fibres^ 
the  canal  appearing  as  if  a  pack-thread  or  riband  was 
tied  around  it. 

But  there  appears  to  be  no  reafon  why  this  contrac- 
tion, if  it  depended  upon  mufcular  action,  mould  take 
place  in  one  part,  and  not  another.  Further,  it  is  a 
well  known  fact,  that  a  very  great  proportion  of  Stric- 
tures of  the  urethra,  do  not  confift  in  a  diminution  of 


*3 
the  whole  circumference  of  the  canal,  but  are  frequent/ 
ly  confined  to  a  very  fmall  part  of  it.     Now,  it  is  ve- 
ry evident,  that  no  action  of  a  tranfverfe  or  circular 
fibre,  would  produce  fuch  an  effect. 

The  difference  of  the  ftream  in  the  evacuation  of 
urine,  and  in  the  emiffion  of  femen,  has  been  adduced 
as  another  evidence  of  the  mufcularity  of  the  urethra* 
But  this  difference  can  be  accounted  for  by  the  com- 
preffion  which  the  canal  fuffers  in  the  diftended  ftate 
of  the  cells  of  the  penis,  the  ftrong  manner  in  which 
the  prepuce  embraces  the  penis  at  the  corona  glandis  ; 
and  the  violent  and  convulfive  action  of  the  ejaculator. 
femmis  mufcle. 

That  the  formation  of  Stricture,  near  the  bulb  of 
the  urethra,  is  influenced  by  the  action  of  the  mufcles 
connected  with  this  pari  is  probably  true ;  as  this  is 
one  of  the  moft  common  feats  of  Stricture  and  of 
fpafm  :  but  it  does  not  neceffarily  follow  that  the  for- 
mation of  Stricture  depends  upon  mufcular  contrac- 
tion, or  even  upon  fpafm. 

The  urethra  has  a  great  number  of  lacunas  open- 
ing into  its  paflage.  They  run  in  a  longitudinal  direc- 
tion, from  behind  forwards.  There  are  two  near  the 
glans  penis,  more  confpicuous  than  the  reft.  Thefe 
lacunae  are  frequently  fo  far  enlarged  by  difeafe,  as  to 
interrupt  the  free  paffage  of  the  bougie  or  catheter  j 
the  point  of  the  inftrument  lodging  in  them. 

From  a  caft,  which  Mr.  Home  made  of  the  ure- 
thra of  a  man  at  80  years  of  age,  it  appears  that  this 
canal  is  feven-twentieths  of  an  inch  in  diameter  in  the 


u 

narrowed  part,  and  eleven-twentieths  in  the  wideft. 
In  a  fubjed  at  thirty  years,  there  was  fome  inconfide- 
rable  variation. 

It  appears,  alfo,  from  thefe  cafts,  that  the  paflage  is 
moil  contra&ed  in  thofe  parts  of  the  canal  moft  liable 
to  Stricture,  viz.  at  four  and  a  half  and  feven  and  a 
half  inches  from  the  external  orifice. 

II.  The  older  furgeons  had  formed  a  very  imper- 
feci:  and  indiftin£t  notion,  with  refpecl:  to  the  real  na- 
ture of  Stricture. 

They  had  afcribed  it  to  fungus  and  caruncles,  or 
flefhy  tumours  fimilar  to  the  polypus  of  the  note  and 
re&um.  * 

It  was  not  till  the  nature  of  Stricture  was  more  com- 
pletely unfolded  by  morbid  diffe&ions,  that  thefe  opin- 
ions were  abandoned.  But  notwithltanding  thefe 
opinions  were  relinquifhed,  one,  perhaps  more  objec- 
tionable, was  embraced  by  Mr.  Hunter ;  which  was, 
that  the  difeafe  confifted  in  a  mere  contraction  of  the 
fibres  of  the  lining  membrane  of  the  urethra.  This 
contraction  was  fuppofed  to  be  partial,  in  the  firft  in- 
stance, but  eventually  to  become  fo  confiderable  a^ 
completely  to  obftrudt  the  paflage  of  urine. 

This  opinion  we  do  not  feel  difpofed  to  admit,  for 
the  reafons  already  given.  It  can  hardly  be  fuppofed 
that  a  Permanent  Stricture  can  be  induced  in  this  ca- 
nal by  the  contraction  of  a  fmgle  or  a  fet  of  fibres,  if 
thefe  fibres  be  endowed  with  the  properties  of  mufcu- 
larity  to  which  relaxation  as  well  as  contraction  is  ef- 
fential.     This  fuppofed  unyielding  tonic  fpafm,  has  no 


15 

analogy  with  any  phenomenon  exhibited  in  any  other 
part  of  the  body,  in  health  or  difeafe. 

We  fhould,  therefore,  hardly  be  willing  to  admit, 
even  if  mufcular  fibres  were  found  to  exift  in  this 
membrane,  that  their  contraction  could  be  productive 
of  Stricture.  This  opinion  is  more  particularly  in- 
dulged, from  taking  into  confideration  the  extreme 
degrees  of  relaxation  and  tenfion  which  this  mem- 
brane in  rapid  fucceffion  undergoes.*  We  are  by  no 
means  drove  to  the  neceflity  of  attributing  the  forma- 
tion of  this  difeafe  to  fuch  a  caufe,  when  we  reflect, 
that  in  the  mod  healthy  ftate  of  this  canal,  this  mem- 
brane is  puckered  and  thrown  into  a  great  number  of 
loofe  folds,  by  the  compreflion  which  the  canal  fuffers 
from  diftenfion  of  the  cells  of  the  penis,  when  erected, 
and  the  violent  action  of  the  mufcles  furrounding  the 
bulb  of  the  urethra,  in  the  expulfion  of  the  urine  and 
femen. 

The  real  caufe  of  the  fimpleft  form  of  Stricture, 
which  gives  the  idea  of  the  paflage  being  embraced  by 
a  cord,  appears  to  be  inflammation  of  the  Urethra  ;f 
caufing  a  thickening  of  the  internal  membrane  of  this 
paflage.  Another  confequence  of  this  procefs,  and 
one  which  contributes  to  the  obftruction,  is  an  effu- 
fion  of  lymph  exterior  to  this  membrane  ;  by  which 

*  In  the  London  Medical  Review,  vol.  3d,  a  cafe  is  related  of  a  boy, 
3ged  four  years,  in  whom  the  urethra  was  dilated  to  fuch  an  extent  by 
means  of  fpOnge,  that  it  permitted  three  calculi  of  the  fize  of  a  large 
nutmeg  to  pafs.  They  were  of  an  irregular  wedge-like  £hape,  and  weigh- 
ed, on  an  average,  from  fixty  to  feventy  grains  each. 

f  This  opinion  has  been  advocated  by  Mr.  C.  Bell,  and  other  diftin- 
guifhed  Surgeons* 


i6 

means  adheiions  take  place,  the  cells  of  the  penis  are 
glued  together,  and  a  ridge  is  formed  which  projects 
into  the  urethra.  The  broad  or  riband  Stricture, 
appears  to  afiume  this  form,  by  a  diminution  of  the 
canal  taking  place  in  the  interfpace  between  two  Am- 
ple Strictures,  which  previoufly  exifted.  This  kind 
of  Stricture  is  alfo  induced  by  inflammations  \  and,  in 
iome  inftances,  acquires  almoft  a  cartilaginous  hard- 
nefs,  and  calls  for  the  moil  affiduous  perfeverance  in 
the  ufe  of  cauftic  for  its  removal. 

The  Stricture  in  which  there  is  a  thickening,  of 
folding  of  the  internal  membrane,  forming  a  ridge  in 
the  fide  of  the  canal3  is  obvioufly  owing  to  the  fame 
caufe  as  thofe  before  mentioned.  Two  or  three  of 
this  kind  are  frequently  met  with  in  the  courfe  of  the 
urethra,  and  can,  in  general*  be  readily  diftinguifhed, 
by  the  imprefliofi  which  they  make  on  the  bougie. 

Inflammation  and  fpafm  are  frequent  concomitants 
of  Permanent  Stri&ure  of  the  Urethra.  The  latter 
probably  ariies  from  the  fyrnpathy  which  exifts  be- 
tween the  fphinfter  vefic&  and  the  lining  membrane 
of  the  paffage.  Any  caufe  which  gives  rife  to  irrita- 
tion in  the  Urethra,  will  produce  fpafm  ;  as  the  in- 
troduction of  the  bougie,,  the  application  of  cauftic^ 
coition-,  intemperance  in  drinking,  expofure  to  the  vi- 
dfhtudes  of  weather,  violent  exertions,  non-compli- 
ance with  the  calls  of  nature  in  evacuating  the  blad- 
der, &c.  &c* 

When  from  any  of  thefe  caufes  fpafm  is  induced;, 
bleeding,  the  warm  bath,  and  anodynes.,  generally  af- 
ford relief, 


»7 

As  has  been  before  obferved,  Strictures  moft  com- 
monly  occur  about  feven  inches  from  the  external 
orifice,  juft  at  the  point  where  the  membranous  part 
of  the  urethra  terminates  in  the  bulb. 

This  point,  it  has  been  fully  afcertained,  is  the  moft 
irritable  part  of  the  urethra.  We  are  in  poffeffon 
of  fads  which  lead  to  the  belief  that  it  is  the  feat  of 
fpafm  in  ftrangury,  induced  from  the  application  of 
blifters.  Another  fact  which  proves  this  part  to  be 
more  peculiarly  irritable,  is,  that  it  is  fympathetieally 
affected,  if  we  may  be  allowed  the  expreflion,  with 
inflammation  in  gonorrhea  virulenta,  Thefe  circum- 
ftances,  without  doubt,  give  rife  to  the  more  frequent 
occurrence  of  obftructions  in  this  part  of  the  canal. 

The  next  moft  frequent  feat  of  the  difeafe,  is  at  the 
point  where  the  penis  takes  its  bend  from  the  pubis, 
about  four  and  a- half  inches  from  the  extremity  of 
the  glans. 

Why  this  part  mould  be  more  than  commonly  fub- 
ject  to  Stricture,  is  obvious  from  the  circumftance  of 
the  canal  at  this  point,  inftead  of  being  left  loofe  and 
free,  as  in  other  parts  of  its  courfe,  being  fupported 
by  the  Ugamentum  fufpenforium,  by  which  means  an 
acute  bend  is  made,  and  this  part  receives  the  whole 
force  of  the  urine  in  its  expulfion. 

Irritation  and  inflammation  from  gonorrhaa,  or  any 
other  caufe,  extending  to  this  part,  is  kept  up  by  this 
means,  and  refults  in  the  formation  of  Stricture.  Ob- 
ftructions  very  frequently  occur  within  two  or  three 
Inches  of  the  extremity  of  the  urethra ;  the  occur- 
C 


i8 

rence  of  them  at  this  part  is  doubtlefs  owing  to  its 
being  the  ufual  feat  of  inflammation  in  gonorrhoea. 

Befides  thofe  parts  already  mentioned,  Strictures 
fometimes  take  place  juft  at  the  extremity  of  the  ca- 
nal ;  but  thefe  cafes  are  comparatively  rare. 

III.  From  the  view  which  we -have  taken  of  the 
fubject,  it  is  obvious  that  Stricture  may  arife  from  any 
caufe  producing  inflammation  of  the  urethra. 

One  of  the  mod  common  caufes,  therefore,  is  gon- 
orrhoea virulenta.  This  fo  commonly  gives  rife  to  it, 
that  we  may  venture  to  aflfert,  that  five  cafes  out  of 
fix  arife  from  this  difeafe.  The  effects  of  it  are  pre- 
cifely  fuch  as  we  have  defcribed  as  producing  Stric- 
ture. In  the  firft  inflance,  a  thickening  of  the  mem- 
brane takes  place  \  the  inflammation  extending  deeper 
into  the  reticular  membrane  of  the  penis,  an  effufion 
of  lymph  follows,  adhefions  form,  and  the  fides  of  the 
canal  are  thrown  into  more  immediate  contaft.  When 
irritation  has  once  begun,  it  is  kept  up ;  the  Stricture 
becomes  firmer  and  more  perfect,  till  an  almoft  total 
interruption  to  the  paflage  of  urine  is  induced. 

Another  very  common  caufe  of  Stricture,  is  the  ufe 
of  ftrong  injections,  or  the  employment  of  them  at 
an  improper  period  for  the  cure  of  gonorrhoea. 

The  paflage  of  calculi  through  the  urethra,  which 
from  the  mechanical  violence  produced,  caufes  in- 
flammation, though  feldom  acknowledged  as  a  caufe 
of  Stricture,  is  doubtlefs  much  more  common  than  is 
generally  admitted. 

Frequent  and  long  continued  action  of  the  mufcles 
turrounding  the  urethra,  as  in  difficult  mi&urition. 


*9 
and  in  coifu,  becomes  likewife  another  fource  of  Stric- 
ture, from  the  irritable  and  inflamed  ftate  of  the  ure- 
thra induced  thereby.  The  intemperate  ufe  of  vinous 
and  fermented  liquors,  the  mechanical  violence  done 
to  the  parts,  and  the  formation  of  abfcelTes  in  the  pe- 
nis, have  been  frequent  caufes  of  Stricture. 

Deep  and  foul  chancres  have  in  fome  inftances 
been  followed  by  Stricture,  in  confequence  of  the  in- 
flammation extending  to  the  lining  membrane  of  the 
urethra.  The  unnatural  vice  of  felf-pollution,  alfo, 
hsemorrhois,  and  other  affections  of  the  rectum, 
may  be  included  among  the  caufes  of  this  difeafe. 

LV.  It  has  been  generally  remarked,  tfiat  the  fymp- 
toms  of  Stricture  in  the  firft  inflance,  give  fo  little  in- 
convenience that  they  pafs  unnoticed  by  the  patient. 
A  diminution  in  the  ftream  of  urine,  with  more  fre- 
quent calls  than  natural  to  evacuate  the  contents  of 
the  bladder,  uneafinefs  experienced  in  the  courfe  of 
the  urethra  and  at  the  neck  of  the  bladder,  and  a 
gleety  difcharge  from  the  canal,  are  among  the  fymp- 
toms  which  firft  excite  the  patient's  attention,. 

Mod  of  thefe  fymptoms  are  aggravated  by  any 
thing  which  produces  irritation  in  thefe  parts ;  as  ex- 
ceffes  in  drinking ;  violent  exercife^,  particularly  on 
horfeback,  or  in  a  carriage ;  indulgences  with  wo- 
men ;  difob^iience  to  the  calls  of  nature  in  evacuat* 
ing  the  bladder  ;  an  attack  of  gowrrhaa  ;  expofure 
fo  cold,  &c.  &c* 

Thefe  caufes  frequently  give  rife  to  fpafm,  and  a 
total  fuppreffion  of  urine  is  the  confequence.  A  very 
painful  fenfation  is   fometimes  experienced  in   the 


20 

courie  of  the  urethra,  in  the  act  of  coition,  and  the 
femen  inftead  of  paffing  in  its  proper  channel  is  thrown 
back  into  the  bladder. 

In  other  inftances,  confiderable  finarting  takes 
place,  and  a  difcharge  from  the  urethra  follows, 
which  is  liable  to  be  miftaken  for  gonorrhea.  The 
Stricture  becomes  more  complete,  the  patient  is  con- 
tinually harraffed  with  a  defire  to  pafs  urine ;  which 
is  evacuated  in  a  fmall  ftream  or  by  drops,  and  is 
obliged  frequently  to  rife  from  bed  in  the  courfe  of 
the  night. 

Violent  pain  is  experienced  in  the  fmall  of  the  back 
and  in  the  loins  :  uneafinefs  in  the  groins  perinaeum 
and  upper  part  of  the  thighs. 

The  patient  has  involuntary  emimons  of  femen ; 
and  very  frequently,  from  lofs  of  power  in  the  blad- 
der, has  incontinence  of  urine.  The  fyftem  at  large 
partakes  of  difeafe  from  fympathy.  A  paroxjrfm  of 
fever,  refembling,  in  every  effential  point,  an  attack 
of  intermittent,  very  frequently  occurs  in  thofe  affect- 
ed with  Stricture.  Any  flight  excefs,  expofure  to  vi- 
ciflitudes  of  weather,  undue  exertions  of  body,  the 
introdu&ion  of  a  bougie  and  application  of  cauftic, 
may  all  be  exciting  caufes  of  a  fit. 

Other  very  common  attendants  are,  derangements 
of  the  ftomach,  want  of  appetite,  naufe^and  vomit- 
ing. To  thefe  may  be  added,  thofe  peculiar  fenfa- 
tions  which  are  the  ufual  accompaniments  of  nervous 
difeafes. 


V.  Strictures  of  the  urethra  frequently  throw  the 
unfortunate  patient  into  the  moil  dangerous  and  loath- 
fome  ftate. 

The  portion  of  the  canal  between  the  Sri&ure  and 
bladder  becomes  dilated,  from  the  circumftance  of  its 
experiencing,  in  a  greater  degree,  the  expulfive  efforts 
of  the  bladder.  Inflammation  follows ;  fometimes  fo 
acute  as  fpeedily  to  deftroy  the  patient.  Under  other 
cireumftances,  it  is  more  flow  in  its  progrefs :  ulcera- 
tion is  produced  ;  the  urine  becomes  effufed  into  the 
furrounding  cellular  membrane ;  foul  and  floughy 
abfeefies  form,  which  burn:  externally  and  form  fiftu- 
3ae,  through  which  the  urine  conftantly  efcapes.  Thefe 
fiftulae  are  frequently  extended  by  the  formation  and 
burfting  of  new  abfcefles. 

The  patient's  general  health,  under  thefe  circum- 
fiances,  fuffers  to  a  great  degree.  He  has  repeated 
paroxjfms  of  fever,  lofs  of  appetite,  profufe  fweats, 
great  debility,  and  not  unfrequently  this  complicated 
fuffering  is  terminated  by  death. 

In  fome  inftances,  the  urine  becomes  fo  extenfively 

effufed  into  the  cellular  membrane,  that  inftead  of  a 

e 

formation  of  matter  being  the  confequence,  fphacilus 
is  immediately  induced,  and  the  patient  is  at  once  de- 
ftroyed. 

One  effect  of  Permanent  Stricture,  is  to  increafe 
the  thicknefs  of  the  coats  of  the  bladder.  This  is 
probably,  in  part,  to  be  afcribed  to  irritation  or  a  lefs 
degree  of  inflammation  being  produced  by  diftention 
of  the  bladder,  and  the  frequent  efforts  which  are 
made  to  pafs  urine  :  but,  it  appears,  in  a  jgreat  meaf- 


22 

ure,  owing  to  the  increafe  of  power  requifite  for  the 
expulfion  of  the  urine,  and  the  confequent  increafe  of 
the  mufcular  fibres  of  this  organ. 

When  a  total  obftru&ion  to  the  paffage  of  urine  oc- 
curs, great  diftention  of  the  bladder,  inflammation  and 
fphacilus,  are  frequent  confequences.  Ulceration  of 
the  bladder,  in  fome  inftances,  alfo  takes  place,  and  is 
accompanied  with  a  difcharge  of  pus  with  the  urine. 
The  ulceration,  it  appears  from  difieftions,  has  extend- 
ed quite  through  the  coats  of  the  bladder,  and  the 
urine  has  been  effufed  into  the  cavety  of  the  abdomen. 
In  other  ijiftances  it  has  not  extended  through  the  pe^ 
ritoneal  coat,  but  the  urine  has  pafled  into  the  cellular 
fubftance  behind  this  membrane. 

The  effects  of  firicture  frequently  extend  beyond 
the  bladder.  The  ureters  becnme  much  enlarged, 
and  at  times  very  much  inflamed.  The  kidneys  like- 
wife  become  diltended  and  inflamed,  by  the  aqjumu- 
lation  of  urine,  and  the  inflammation  not  unfrequent- 
ly  extends  to  the  furrounding  cellular  membrane. 

The  fever  confequent  to  bbftru&ions  in  the  urethra, 
and  accumulation  of  urine,  has  frequently  terminated 
in  eftufions  on  the  brain.  The  fluid  thus  effufed  has 
alfo,  in  fome  inftances,  been  obferved  to  have  a  urin- 
ous fmeil. 

VL  Whatever  might  have  been  the  opinions,  exift- 
ing  formerly,  relative  to  the  treatment  of  Strictures ,• 
there  can  be  but  one,  at  prefent,  among  the  intelli- 
gent of  the  profeflion.  The  bougie  and  the  cauftic 
have  rendered  the  treatment  of  this  difeafe  fo  fafe,  and 
at  the  fame  time  fo  perfect,  that  we  can  not  look  for 


23 

any  material  improvement.  Perhaps  in  no  furgical 
difeafe  involving  fuch  important  confequences,  is  the 
treatment  more  perfect  and  fo  much  to  be  relied  on, 

The  commonly  received  opinion,  that  the  bougie 
operates  by  dilating  a  Permanent  Stricture  like  the 
operation  of  a  wedge,  is  evidently  erroneous :  nor, 
perhaps,  is  the  opinion  that  itsfuccefs  depends  on  the 
production  of  ulceration,  lefs  exceptionable.  Believ- 
ing, as  we  do,  that  Permanent  Stricture  does  not  de- 
pend upon  the  contraction  of  a  fmgle  or  a  fet  of  fibres., 
we  cannot,  for  one  moment,  fuppofe,  that  its  cure  is 
attributable  to  the  dilatation  of  a  contraction  which 
never  exifted. 

That  ulceration,  in  fome  inftances,  takes  place  by 
the  ufe  of  the  bougie,  and  that  a  cure  is  by  this  means 
effected,  is  without  duubt  true  $  and  it  is  equally  true3 
that  when  a  cure  is  thus  effected,  an  unwarrant- 
able and  even  a  hazardous  degree  of  violence  muft 
have  been  employed. 

The  fimple  fact  appears  to  be,  when  the  bougie  iV 
judicioufly  employed,  that  the  preffure  of  the  inftru* 
ment  caufes  an  abforption  of  the  new  formed  fub~ 
fiance,  between  the  folds  of  the  lining  membrane 
forming  the  ridge  in  the  canal.  The  effect  of  pref= 
Aire,  in  promoting  abforption,  is  very  remarkable, 
and  well  illuftrated  in  anurifm  and  in  an  ulcerated 
leg.  In  the  latter  inflance,  the  luxuriant  granulations 
are  abforbed,  and  the  remote  edges  brought  into  more 
immediate  contact,  by  abforption  from  the  cellular 
membrane  of  the  matter  producing  fwelling  ;  both  of 
which  effects  are  brought  about  by  the  equal  and  gm~ 


24 

tie  preffure  of  a  roller  bandage.  By  this  fttode  of 
ufing  the  inflrument,  a  very  large  majority  of  Stric- 
tures may  be  overcome ;  whilll  thofe  dreadful  evils? 
which  are  the  refult  of  the  mod  undue  and  barbarous 
violence,  are  avoided.  It  is  by  ufing  the  bougie  in 
fuch  a  manner  as  to  produce  the  effect  above  men- 
tioned, that  the  furgeon  is  freed  from  the  cenfure 
of  having  made  falfe  paffages  ;  of  having  laid  the 
foundation  of  incurable  fiflulas,  and  of  having  paved 
the  way  to  a  fatal  mortification  of  the  parts.  It  is  by 
the  adoption  of  fuch  pra&ice  alone,  that  he  can  be  ac- 
quitted of  the  imputation  of  cenfurable  ignorance. 

Perhaps  in  every  cafe  where  a  bougie  can  be  paiTed 
into  a  Stricture,  and  the  irritation  is  fuch  as  to  be  ea- 
fily  borne,  this  inflrument  ought  to  be  relied  on  for 
its  removal. 

It  is  true  that  this  mode  of  treating  Stricture  ren- 
ders the  cure  tedious  ;  and  it  is  equally  true,  that  the 
permanency  of  the  cure  is  in  fome  meafure  uncertain. 
Yet  the  prejudices  of  patients  are  fo  ftrong  againft 
the  ufe  of  cauflic,  that  in  general  it  is  better  to  give 
way  to  them  and  adopt  this  mode  of  practice,  in  pre- 
ference to  giving  alarm  and  exciting  unneceiTary  fears. 

The  gum  elaflic  bougie,  in  general,  may  be  prefer- 
red, for  the  cure  of  Strictures  fituate  in  the  part  of  the 
canal  anterior  to  the  bulb  of  the  urethra ;  but  for  thoft 
beyond  this  point  the  common  plafter  bougie  is  pre- 
ferable ;  as  it  more  readily  takes  the  curve  in  the  ure^ 
thra,  and  is  lefs  liable  to  find  for  itfelf  a  new  palfage. 

As  it  regards  the  length  of  time  the  bougie  fhoulc? 
be  permitted  to  remain  in  the  urethra,  wfe  ought,  in 


*5 

every  inftance,  to  be  governed  by  the  degree  of  irrita- 
tion which  is  produced,  and  the  fenfibility  of  the  pa- 
tient to  its  application.  It  may,  in  general,  be  laid 
down  as  a  rule,  that  the  longer  the  inftrument  can  be 
retained  without  material  inconvenience,  the  better. 
The  urethra,  mod:  generally,  in  a  fhort  time  becomes 
accuftomed  to  its  ftimulus,  and  the  cure  advances  with 
much  more  rapidity  than  when  it  is  applied  at  long 
intervals  and  for  a  fhort  period  of  time. 

But  whilft  the  perfevering  application  of  the  bougie 
is  thus  infifted  upon,  in  thofe  cafes  in  which  the  irri- 

.  tation  in  the  urethra  is  flight  and  the  inconvenience 
of  the  application  inconfiderable,  yet,  whenever  much 
pain  is  excited,  followed  by  inflammation,  the  further 
ufe  of  it  becomes  a  queftion.  There  can  be  little  doubt, 
that  in  many  inflances,  it  aggravates  the  difeafe  for  the 

.  eure  of  which  it  is  employed. 

A  pretty  accurate  opinion  can  be  formed  of  thena- 

.  ture  of  the  Stricture,  by  the  impreflion  .made  on  the 

.point  of  the  inftrument,  and  by  the  fenfation  commu- 
nicated to  the  finger.  If  it  mould  be  one  in  which 
the  diminution  is  equal  throughout  the  whole  circum- 
ference of  the  canal,  the  impreflion  will  correfpond  on 
the  point  of  the  inftrument. 

In  like  manner,  if  but  a  part  of  the  circumference 
is  difeafed,  but  a  part  of  the  circumference  of  the  bou= 
gie  will  receive  the  impreflion.  If  the  Stricture  is  un- 
ufually  indurated,  a  fenfation  will  be  communicated  to 
the  finger  as  if  the  inftrument  encountered  a  hard  re- 
filling body.  This  fenfation  is  fimilar  to  that  which 
ivould  be  communicated  by  the  inftrument  coming  in 


contact  with  a  piece  of  cartilage.  This  variety  of  the 
difeafe,  if  it  exift  to  great  extent,  is  feldom  materially 
benefitted  by  the  bougie  ;  it  rarely  yields  but  to  the 
ufe  of  cauftic. 

VIII.  The  application  of  cauftic,  to  a  part  of  fuch 
importance  as  the  urethra,  is  well  calculated  to  excite 
alarm  in  the  minds  of  thofe  unacquainted  with  its 
operation.  This  alarm  would  not  probably  be  leffen- 
ed  from  obferving  the  acute  fenfibility  of  this  canal3 
and  the  intimate  relation  its  healthy  ftate  has  with  im- 
portant functions  of  the  body. 

So  ftrong  have  been  the  prejudices  againft  this  rem- 
edy, that  notwithftanding  the  undeniable  teftimony  we 
have  of  its  fuperior  efficacy,  we  are  not  wanting  in  men, 
Handing  high  in  the  profeffion,  who  would  mrink  from 
its  employment. 

Like  many  other  new  remedies,  it  has  without 
doubt,  in  many  inftances,  been  abufed.  It  has  like 
moft  new  remedies  been  ufed  almoft  indiscriminately ; 
and  we  are  not  to  be  furprifed  that  its  ufe  mould  in 
fom-e  inftances  have  been  attended  with  injurious  con- 
iequences.  But  this  does  by  no  means  militate  againft 
its  general  efficacy  and  value  as  a  remedy. 

Much  of  the  oppofition  to  it  has  unqueftionably 
arifen  from  a  miftaken  notion  relative  to  its  operation^ 
as  well  as  a  want  of  experience  with  regard  to  its  ef- 
fects :  Hence,  thofe  whofe  obfervation  and  experience 
have  been  moft  extenfive,  have  been  the  moft  ftrenu- 
ous  advocates  for  its  employment. 

In  thofe  cafes  in  which  a  bougie  can  not,  without 
violence,  after  perfevering  efforts,  be  pafled  through 


27 

a  Stricture,  there  can  be  no  doubt  that  cauftic  deferves 
the  precedence.  The  irritation  confequent  to  its  ap- 
plication, bears  no  comparifon  to  that  which  follows 
the  violence  ufually  employed  in  pafling  the  bougie 
into  this  kind  of  Stricture. 

There  are  cafes  in  which  the  fmallefl  fized  inftru* 
ment  can  not  even  be  parted  into  the  Stricture.  Un- 
der thefe  circumftances,  the  bougie  ought  to  yield  to 
the  more  efficacious  and  even  fafe  application  of  the 
cauftic.  Every  practitioner  who  has  had  much  expe- 
rience in  this  difeafe  has  met  with  cafes  in  which  there 
was  an  extremely  irritable  ftate  of  the  ftrictured  part,. 

This  peculiar  ftate  of  the  canal  frequently  remains 
obftinately  unyielding  to  the  ufe  of  the  moft  effica- 
cious remedies  ordinarily  employed  for  its  relief.  The 
ufe  of  the  bougie,  under  thefe  circumftances,  aggra- 
vates the  affection  to  an  almoft  infupportable  degree. 
But  this  irritation  will  frequently  yield  to  one  or  two 
applications  of  the  cauftic,  by  which  means  the  fenfi- 
bility  of  the  part  is  deadened  in  the  fame  manner  as 
the  pain  of  an  extremely  irritable  ulcer  is  removed 
by  the  ufe  of  the  fame  remedy.* 

There  is  yet  another  kind  of  Stricture,  which  can 
be  dilated  to  a  certain  extent,  but  which  will  again  re- 
cover itfelf  and  refift  our  perfevering  efforts  with  the 
bougie.  This  form  of  Stricture  requires  for  its  radi- 
cal removal  the  cauftic.  Some  remarks  on  the  ope- 
ration of  this  remedy  would  not  perhaps  be  improper 
in  this  place. 

*  An  ulceration  of  the  cornea  which  is.  rendered  extremely  irritable 
and  painful  by  the  ccnflant  pafTage  of  the  teara  over  the  part,  is  alio  re- 
lieved by  cauftic. 


The  effect  of  the  cauftic  commonly  employed,  is  not 
to  produce  a  deep  and  extenfive  flough  of  the  parts  to' 
which  it  is  applied.  Its  operation  is  more  fuperficiaL 
When  applied  to  a  fungous  excrefence,  it  appears  rath- 
er to  operate  by  ftimulating  the  abforbent  veffels  to: 
remove  the  part,  than  by  producing  an  abfolute  de- 
struction in  the  living  principle. 

Its  effects  are  well  illuftrated  on  that  kind  of  ulcer 
which  has  a  furface  covered  with  fpongy  and  luxuri- 
ant granulations. 

Thefe  granulations  will  rapidly  difappear  by  the  ufe 
of  cauftic,  and  a  florid  healthy  furface  is  prefented, 
ilrongly  difpofed  to  heal. 

In  an  ulcer  of  an  indolent  character,  in  which  the 
difcharge  is  thin  and  gleety,  and  the  granulations  lan- 
guid and  flabby,  by  its  ftimulating  operation  it  con- 
verts the  difeafed  part  into  a  fimple  purulent  ulcer, 
difcharging  well  formed  pus  and  throwing  up  healthy 
granulations. 

It  would  appear,  therefore,  from  thefe  fads,  that  its 
operation  does  not  wholly  confifl  in  caufing  a  deftruc- 
tion  of  parts,  but  that  it  has  the  peculiar  effect  of  chang- 
ing the  difeafed  action,  and  of  promoting  the  abforp- 
t^on  of  morbidly  formed  parts. 

The  manner  of  applying  this  remedy,  as  commonly 
recommended,  is  perhaps,  generally  fpeaking,  unex- 
ceptionable. We  firft  pafs  a  moderate  fized  bougie, 
well  befmeared  with  oil,  down  to  the  Stricture,  and 
mark  on  the  inftrument  the  diftance  of  the  Stricture 
from  the  external  orifice.     After  the  bougie  is  with- 


29 

drawn  we  oil  the  armed  inftrument,  and  having  given 
it  the  proper  curve,  introduce  it  into  the  urethra  and 
pafs  it  fteadily  forward  till  it  encounters  the  Stricture, 

The  length  of  time  the  cauftic  fliould  be  permitted 
to  remain  in  contad  with  the  Striclure,  mull  be  in-, 
fluenced  altogether  by  the  fenfibility  of  the  patient  to 
its  application.  In  general,  half  a  minute  will  be  fuf- 
ficient ;  in  fome  inftances  it  cannot  be  retained  fo  long, 
whilft  in  other  cafes  no  great  inconvenience  is  experi- 
enced from  its  being  applied  a  greater  length  of  time. 

Whilft  houfe  furgeon  to  the  New-York  hofpital,  F 
had  an  opportunity  of  obferving  the  effects  of  another 
mode  of  applying  cauftic,  which  was  firft  fuggefted 
and  employed  by  the  diftinguimed  and  practical  fur- 
geon doctor  Richard  S.  Kiflam*  one  pf  the  furgeons 
&£  that  institution. 

This^  method  of  applying  cauftic  does  not,  in  princi- 
ple, eftentially  differ  from  thofe  which  have  heretofore 
been  recommended  ;  but  under  certain  circumftances 
it  appears  to  poffefs  a  decided  fuperiority.  It  confifts 
in  firft  dipping  the  extremity  of  a  fmall  fized  gum  elaf- 
tic  bougie  into  a  faturated  folution  of  cauftic.  The 
inftrument  is  then  to  be  laid  afide,  for  a  fhort  time, 
that  the  cauftic  may  concrete.  A  canuia  is  after- 
wards introduced  into  the  urethra,  and  carried  down 
to  the  obftruction,  and  the  bougie  thus  armed  is  paifed 
through  this  inftrument  into  the  Stricture. 

In  Strictures  extending  fome  diftance  in  the  courfe 
of  the  canal,  this  manner  of  employing  cauftic  prom* 
ifes  to  be  peculiarly  ufeful. 


Many  of  thefe  Strictures  are  remarkably  firm  and 
indurated,  and  their  cure  by  the  application  of  cauftic* 
in  the  common  manner,  is  often  tedious  and  protract- 
ed. This  can  in  a  great  meafure  be  obviated  by  em- 
ploying the  bougie  dipped  in  a  cauftic  folution. 

It  poffefles  all  the  combined  advantages  of  the  cauf- 
tic and  common  bougie,  and  not  only  operates  in  de- 
ftroying  the  ftricture  in  the  fame  manner  as  the  com- 
mon armed  inftrument,  but  it  alfo  a&s  laterally  on  the 
ftri&ured  part,  by  which  means  the  difeafe  is  cured 
with  much  more  facility  than  when  the  ordinary  me- 
thod is  employed. 

The  application  of  the  common  armed  bougie  is 
fometimes  followed  by  a  total  fuppreffion  of  urine9 
which  not  only  creates  material  inconvenience,  but  in 
fome  inftances  ferious  apprehenfions  for  the  fafety  of 
the  patient.*  This  effect  is  caufed  by  the  Hough  which 
is  feparated  by  the  cauftic  ;  and  probably,  alfo,  by  the 
effufed  lymph  obftru&ing  the  canal.  As  far  as  my 
obfervation  extends,  this  effect  never  has  nor  is  likely 
to  follow  the  ufe  of  the  bougie,  armed  with  the  cauftic 
folution.  1  think  I  am  further  warranted  in  faying, 
that  the  irritation  which  follows  the  ufe  of  cauftic 
in  this  way,  is  confiderably  lefs  than  what  follows  that 
of  the  common  armed  inftrument.  This  probably  is 
owing  to  the  remedy  being  applied  more  extenfively 
to  the  irritable  furface,  by  which  means  its  fenfibilitj 
is  diminifhed  to  a  greater  extent  than  by  a  more  par- 
tial application  of  cauftic.     There  is  another  mifchiev- 

*  See  cafe  in  the  appendix. 


3* 
ous~  effect  avoided  ;  which  is,  the  flipping  of  the  cauk 
tic  from  the  bougie  into  the  urethra,  during  its  appli- 
cation. 

This  mode  of  ufmg  cauftic  is  more  particularly  ap- 
plicable to  Strictures  fituate  anterior  to  the  membran- 
ous part  of  the  urethra ;  but  it  may  be  applied  be- 
yond this  point,  without  difficulty,  if  a  filver  or  gum 
elaftic  catheter,  the  extremity  of  which  has  been  re- 
moved, be  ufed  for  a  canula. 

A  folution  of  the  lunar  cauftic  may  be  employed 
for  arming  the  bougie,  or  the  corrofive  muriate  of 
mercury,  both  of  which  folutions  mould  be  faturated 
in  excefs,  in  order  that  a  concretion  may  readily  take 
place  on  the  inftrument. 

Another  cauftic,  and  one  which  appears  preferable 
to  either  of  the  above,  is  formed  by  the  union  of  equal 
parts  of  the  corrofive  muriate  of  mercury  and  water, 
with  the  additition  of  fufficient  of  the  muriate  of  am- 
monia to  render  the  fublimate  foluble.  By  dipping 
the  extremity  of  the  inftrument  into  this  folution,  a 
fmall  quantity  remains  on  it  and  afiumes  a  cryftalized 
form. 

It  perhaps  might  be  objected,  that  this  cauftic  would 
probably  be  productive  of  too  violent  effects  on  fo  ir- 
ritable a  part  as  the  urethra ;  but  the  fmall  quantity 
of  cauftic  which  adheres  to  the  inftrument,  will  effect 
ually  prevent  any  of  thofe  bad  confequences  which 
might  be  naturally  apprehended. 

I  feel  perfuaded,  from  the  trials  which  I  have  made 
of  it,  that  if  it  is  cautioufly  employed  it  h  Ids  likely 


.32 

to  be  followed  by  inflammation  than  when  the  com- 
mon mode  of  applying  cauftic  is  adopted. 

With  refpect  to  the  cauflic  potalh,  which  has  been 
fo  favorably  fpoken  of  by  Mr.  Whately,  its  ufe  has 
been  fo  limited  in  this  country,  as  hardly  to  admit  of 
an  opinion  being  formed  from  the  experience  of  our 
own  furgeons.  Its  efficacy,  however,  has  been  fully 
tefted  by  the  furgeons  of  Europe,  and  it  does  by  no 
means  appear  to  have  equalled  the  expectations  form- 
red  of  it  upon  the  recommendation  of  fo  refpectable 
authority. 


APPENDIX. 


1  he  following  cafes  are  fubjoined  more  particularly 
for  the  purpofe  of  illuftration,  than  from  any  peculiar  cir- 
cumstances attending  them  :  for  this  reafon  the  more  prom- 
inent circumftances  are  briefly  noticed,  in  preference  to  en- 
tering into  a  more  minute  detail.  There  are  feveral,  how- 
ever, which  may  not  be  wholly  uninterefting  to  thofe  whofe 
obfervation  has  been  confined  to  the  cafes  which  ordinarily 
occur  in  private  practice. 

Cafes  of  Simple  Striclure,  in  which  the  common  Bougie  was 
employed* 

P — r  D y,  aged  59  years,  feaman,  was  admitted 

into  the  New- York  hofpital,  Auguft  30,  1814,  with  Stricture 
of  the  urethra.  He  had  been  affected  with  the  difeafe  1 5 
years.  He  voided  his  urine  fome  times  by  drops,  at  others 
in  a  forked  ftream. 

The  ufe  of  the  common  bougie  was  directed  night  and 
morning  for  his  relief :  the  employment  of  the  inftrument 
was  followed  by  confiderable  hemorrhage  from  the  urethra, 
at  every  application,  but  no  material  irritation  enfued. 

On  the  4th  of  September,  the  Stricture  was  patted,  and 
on  the  28th  the  patient  was  difcharged.  At  this  time  he 
could  pafs  his  urine  in  as  full  a  ftream  as  ever,  although  a 
boUgie  of  the  largeft  fize  had  not  been  pafTed  into  the  bladder, 

J — — n  R_e,  born  in  Scotland,  aged  42  years,  was 
received  into  the  New-York  hofpital  April  12,  1814,  with 
Stricture.  He  began  to  experience  difficulty  m  difcharging 
E 


34 

urine  nine  years  before,  and  for  the  laft  fix  had  paflfed  it 
guttatim* 

A  Stricture  was  encountered  at  about  five  and  a  half  inch- 
es from  the  extremity  of  the  glans  penis.  By  the  afliduous 
employment  of  the  elaftic  gum  bougie,  one  of  a  fmall  fize 
was  paused  through  three  days  after  his  admiffion,  A  larger 
inftrument  was  then  ufed,  and  the  fize  gradually  increafed. 
On  the  23d  of  April  he  was  difcharged  from  the  hofpital. 
Five  months  after  this  period  he  had  no  return  of  difficulty 
in  evacuating  his  urine. 

B e  H d,  born  in  the  ifland  of  Cape  de  Verd, 

aged  33  years,  feaman,  was  admitted  June  16,  181 4,  with 
Stricture  of  the  urethra,  and  fyphilis.  The  Stricture  was  fit- 
uate  about  fix  inches  from  the  extremity  of  the  glans.  He 
palTed  his  urine  frequently  and  in  a  fmall  ftream  ;  had  pain 
in  the  loins,  &c.  He  was  put  on  the  ufe  of  the  ufual  rem« 
edies  for  the  cure  of  fyphilis,  which  difeafe  he  had  in  the 
form  of  chancre  and  bubo. 

After  the  difappearance  of  thefe  fymptoms,  a  fmall  fized 
gum  elaftic  bougie  was  panned  through  the  Stricture  with 
fome  difficulty,  and  from  the  little  irritation  which  the  in- 
ftrument produced,  he  was  able  to  retain  it  in  the  urethra 
almoft  uninterruptedly. 

At  the  time  he  was  difcharged,  (July  27,)  a  bougie  of 
large  fize  could  be  readily  introduced  into  the  bladder,  and 
the  urine  was  difcharged  in  a  full  ftream. 

j s  O'B n,  born  in  Ireland,  aged  4 1  years,  waiter, 

was  admitted  into  the  New- York  hofpital  May  4,  18 14, 
with  Stricture.  He  contracted  gonorrhoea  about  twelve  months 
previoufly,  and  had  experienced  difficulty  in  evacuating  his 
urine  ever  fince  that  period.  He  had  Stricture  fituated  about 
two  inches  from  the  extremity  of  the  penis.  This  one  could 
be  pafTed  by  a  fmall  fized  bougie.  There  was  alfo  another 
about  fix  inches  from  the  external  orifice.     The  patient  had 


35 
pain  in  the  lumbar  region,  and  in  the  perineum,  a  flight 
difcharge  from  the  urethra  and  fcalding  in  making  water. 

The  common  bougie  was  employed  in  the  ufual  manner 
for  his  relief,  and  on  the  19th  of  May  a  fmall  one  was  paff- 
ed  into  the  bladder.  This  inftrument  was  afterwards  ex- 
changed for  one  of  a  larger  fize,  and  the  patient  was  fo  com- 
pletely relieved,  that  he  was  difcharged  from  the  hofpital  on 
the  13  th  of  June. 

J n  H n,  aged  26  years,  was  admitted  on  the  8th 

of  November  with  Stricture.  He  had  -been  laboring  under 
the  difeafe  for  two  or  three  years.  He  paffed  his  urine  in 
a  very  fmall  ftream,  with  much  difficulty,  and  had  occafion- 
al  attacks  of  ague  with  fever.  A  Stricture  was  paffed  at 
about  fix  inches  from  the  external  orifice,  by  «a  moderate 
fized  bougie.  Its  further  prqgrefs  was  interrupted  at  about 
feven,  by  another  Stricture.  The  bougie  was  feveral  times 
pafied  into  this,  by  which  means  the  patient  was  enabled  to 
evacuate  his  urine  with  freedom.  The  inftrument,  however, 
was  never  introduced  into  the  bladder.  The  patient  having 
been  fo  materially  relieved,  refufed  to  remain  in  the  houfe 
till  a  cure  could  be  effected. 

Cafes  of  Strifiure  with  Fifluia  relieved  by  the  Bougie, 

J n  P— — s,  bom  in  Grenada,  aged  27  years,  a  col- 
ored fervant,  was  admitted  February  5,  18 14.  The  patient, 
at  the  time  of  his  admiflion,  had  incontinence  of  urine.  He 
had  alfo  a  fiftulous  opening  a  little  anterior  to  the  fcrotum, 
through  which  the  greater  part  of  the  urine  was  difcharged. 
There  was  confiderable  hardnefs  and  thickening  about  the 
opening.  The  fcrotum  was  fwollen,  thickened  and  hard  ; 
and  the  prepuce  had  undergone  the  fame  change  and  pro- 
jected about  two  inches  beyond  the  glans  penis,  The  patient 
complained  of  great  pain  and  forenefs  of  the  parts.  This 
'rate  of  parts,  it  appeared  from  the  patient's  own  account,. 


36 
had  arifen  from  the  dFufion  of  uriiie  into  the  cellular  mem- 
brane.    He  had,  with  his  other  fymptoms,  great  pain  in  the 
loins  and  perinaeum.     His  general  health  rather  impaired. 
On  paffing  a  bougie  into  the  urethra  a  Stricture  was  found 
to  exift  three  and  a  half  inches  from  the  external  orifice. 
He  had  been  affected  with  clap  fix  years  before,  and  began 
to  experience  difficulty  in  difcharging  his  urine  fix  or  eight 
months  before  his  admiffion,  attended  with  frequent  and 
urgent  defire  to  evacuate  the  contents  of  the  bladder.     Six 
weeks  before  he  was  admitted,  the  difficulty  became  fo  great 
that  the  urine  could  only  be  pafTed  in  drops,  and  in  a  fhort 
time  he  pafTed  it  involuntarily.     About  three  weeks  after 
this,  ulceration  took  place,  and  the  urine  was  difcharged 
through  the  opening  anterior  to  the  fcrotum.     About  this 
time  the  fcrotum  and  prepuce  became  fuddenly  fwollen,  and 
from  this  period  to  that  of  his  admiflion  into  the  hofpital, 
he  experienced  much  pain.     A  fmall  fized  bougie  was  pafTed 
into  the  Stricture,  and  directed  to  be  retained  as  long  as  the 
ftate  of  the  parts  would  permit.     The  ufe  of  the  inftrument 
was  continued  till  the  i  oth  of  February,  at  which  time  one 
Stricture  was  overcome  :  but  another  was  immediately  en- 
countered, fo  that  the  fymptoms  of  the  patient  were  in  n# 
way  relieved.     On  the  16th  of  February,  he  was  directed  to 
take  of  the  Spir.   Terebin.  one  drachm  in  an  emulfion  of 
gum  Arabic  daily ;  and  a  blifter  was  applied  to  the  perinae- 
um.    On  the  2 oth  he  had  not  been  benefitted  by  the  rem- 
edies directed  on  the  1 6th.     He  complained  of  confiderable 
pain  at  the  neck  of  the  bladder,   which  he  attributed  to  his 
medicine.     At  this  time  the  bougie  could  be  introduced  a 
little  further.     On  the  17  th  of  March  a  fmall  fized  inftru- 
ment was  palled  into  the  bladder.     On  the  23  d  he  was  able 
to  retain  his  urine  half  an  hour,  and  but  little  was  difcharg- 
ed by  the  fiftulous  opening.     At  this  time  a  bougie  of  con- 
fidcrable  fize  was  pafTed  into  the  bladder,     The  fiftulous 


37 
opening  was  completely  healed  on  the  9th  of  April.  On 
the  1 6th  of  May,  three  and  a  half  inches  of  the  prepuce 
which  had  become  elongated  and  converted  into  a  peculiar 
ligamentous  fubftance,  was  cut  off.  After  this  period  a  tu- 
mor made  its  appearance  at  the  part  where  the  opening  had 
previoufly  exifted,  anterior  to  the  fcrotum.  This  tumor 
fuppurated  and  prevented  the  patient's  being  difcharged  till 
the  5th  of  Auguft. 

C — — s  K— y,  born  in  England,  aged  68  years,  (hoe- 
maker,  was  admitted  into  the  New-York  hofpital  Auguft  5, 
18 14,  with  fiftuU  in  perin<£Q)  connected  with  finufes  in  the 
neighboring  parts.  The  urine  was  difcharged  in  considera- 
ble quantities  through  the  opening,  and  the  patient's  gener- 
al health  confiderably  impaired.  There  was  djfttric'ture  fit- 
uate  about  four  inches  from  the  external  orifice.  He  had 
once  been  affected  with  gonorrhoea.  He  was  firft  affected 
with  fiftula  three  years  before  he  was  admitted,  and  it  had 
been  healed  feveral  times,  and  again  broken  out.  After  h^.s 
reception  the  fiftula  was  freely  dilated  to  give  a  ready  exit  to 
the  pus  and  urine.  A  bougie,  alfo,  of  fmall  fize,  was  paffed 
into  the  Stricture,  and  in  the  courfe  of  one  week,  by  its  cau- 
rious  application,  the  Stricture  was  overcome.  This  was 
followed  by  immediate  relief  in  all  the  fymptoms  of  the  pa- 
tient ;  the  fiftula  rapidly  healed,  and  he  was  difcharged  on 
the  30th  of  Auguft. 

Cafes  of  Stritlure  with  JFijlula  in  Perinteoy  in  which  the  common 
armed  Bougie  was  employed. 

V— — s  J  ff,  born  in  Germany,  aged  53  years,  who 
followed  the  profeflion  of  porter,  was  admitted  1 7th  Decem- 
ber, 18 1 3,  with  Stricture.  In  July  of  the  fame  year,  the 
patient  received  a  very  fevere  injury  in  the  perinseum,  by 
falling  aftride  the  chime  of  a  ca£k.  This  injury  was  follow- 
M  by  effufion  of  urine,  and  Houghing  of  the  perineum  and 


3» 
urethra.  The  urine  was  difcharged  through  an  opening  in 
perinxo  two  or  three  weeks  after  this  period,  but  he  was  (6 
far  recovered  as  to  be  difcharged  from  the  hofpital  on  the 
i  oth  of  September  following.  The  perinaeum  was  feveral 
times  ulcerated  after  he  left  the  hofpital,  but  he  did  not  ex- 
perience any  material  obftruction  in  the  paffage  of  his  urine, 
till  four  days  previous  to  his  fecond  admiffion.  The  com- 
mon bougie  was  firft  employed.  On  the  firft  of  January 
the  obftruetion  ftill  continued,  and  the  old  fijlula  in  perina* 
had  again  opened.  The  cauftic  at  this  time  was  directed  to 
be  ufed.  The  patient  was  difcharged  from  the  hofpital  on 
the  1 1  th  of  March,  cured  of  both  affections. 

C— ee  W-v,  d,  born  in  Africa,  was  admitted  into  the 
hofpital  A9IMP25,  1814.  Tne  patient,  at  the  time  of  his 
admiffion,  had  a  fiftulous  opening  in  the  perinaeum,  through, 
which  the  urine  conftantly  efcaped,  and  he  paffed  it  alfogwf- 
iatim  by  the  natural  paffage.  He  was  unable  to  give  any 
fatisfadtory  account  of  his  previous  difeafe.  A  Stricture  was 
found  to  exift  five  inches  from  the  extremity  of  the  penis. 
A  bougie  of  fmall  fize  was  introduced  into  the  Stricture,  and 
kept  applied  for  fome  time  every  day.  On  the  fourth  day 
the  Stricture  was  paffed ;  a  larger  fized  inftrument  was  then 
employed.  The  fijlula  in  perinao  was  healed  in  a  fortnight 
after  his  admiffion,  and  he  was  difcharged  from  the  hofpital 
on  the  28th  of  June.  On  the  16th  of  September  the  pa- 
tient again  returned  to  the  hofpital,  with  fijlula  in  perinao9 
and  difficulty  in  paffing  his  urine.  With  thefe  fymptoms 
he  alfo  had  occafional  febrile  paroxifms.  The  common  bou- 
gie was  again  reforted  to,  and  was  employed  for  fome  time 
with  very  little  advantage :  it  was  then  laid  afide,  and  the 
cauftic  applied.  On  its  fecond  application  the  principal 
Stricture,  fituate  at  about  {even  inches  from  the  external  or- 
ifice, was  paffed.  The  opening  in  the  perinaeum  was  very 
foon  after  this  clofed.     In  October,  an  ordinary  fized  cathe- 


39 

ter  was  introduced  into  the  bladder  with  eafe.  By  the  in* 
cautious  ufe  of  the  bougie,  by  himfelf,  after  this  period,  con- 
iiderable  inflammation  was  produced,  which  was  fucceeded 
by  the  formation  of  another  fiftulous  opening  in  the  perinse- 
um.  The  patient  was  difcharged  from  the  hofpital  on  the 
1 8th  of  January,  1815,  at  which  time  the  fiftula  had  healed 
and  he  difcharged  his  urine  without  difficulty, 

Cafes  of  Strifture  with  incontinence  ofnrine,  treated  by  Cauflic. 

W- m  D — — n,  born  in  the  ftate  of  Delaware,  aged 

39  years,  feaman,  was  admitted  18th  of  January,  18 14.  He 
complained  of  incontinence  of  urine,  and  had  a  gleety  di£» 
charge  from  the  urethra.     The  patient  alfo  had  pain  in  the 
loins  and  forenefs  of  the  groins  and  perinseum,  with  a  fenfe 
of  dragging  and  weaknefs.     The  progrefs  of  the  bougie  was 
flopped  at  four  and  a  half  inches  from  the  extremity  of  the 
penis.   The  patient  was  affected  with  clap  in  February,  18 13* 
for  the  cure  of  which  he  employed  an  injection,  but  with 
very  little  benefit.     The   difeafe  was  attended  with  violent 
cberdee,  which  (as  the  patient  fuppofed)  caufed  a  rupture  of 
the  urethra,  and  was  followed  by  copious  hemorrhage.     He 
entered  on  board  the  frigate  United  States  in  the  month  of 
April ;  foon  after  which  period  the  difcharge  from  the  ure- 
thra began  to  diminifh,  and  at  the  fame  time  he  obferved  that 
the  ftream  of  urine  was  decreafed  in  fize.     In  July  he  had 
an  attack  of  nervous  fever  ;  during  which  period  the  diffi- 
culty in  difcharging  urine  was  increafed,  attended  with  great 
pain  and  frequent  and  urgent  calls  to  evacuate  the  bladder. 
The  bougie  was  employed  a  few  times  at  this  period,  with- 
out any  advantage.     Soon  after  he  began  to  pafs  his  urine 
involuntarily,  became  much  debilitated,  and  was  difcharged 
from  the  frigate  unfit  for  duty.     After  his  admiffion,  the 
common  bougie  was  employed  for  fome  time  without  afford- 
ing hiav  any  relief  j  from  this  circumftance  it  was  thought 


40 

advifable  to  apply  the  cauftic.  It  was  accordingly  employed,, 
and  on  the  third  application  the  Stricture  was  overcome, 
The  pain  in  the  loins,  incontinence  of  urine,  and  other  dif= 
treffing  fymptoms,  from  this  period  left  him,  and  he  was 
difcharged  from  the  hofpital  on  the  1 8th  of  February.  Nine 
months  after  this  period,  he  had  experienced  no  difficulty 
from  his  previous  difeafe. 

P- -o  B— — y,  born  in  Philadelphia,  aged  36  years,  fer- 

vant,  was  admitted  nth  of  February,  18 14,  with  Stricture, 
He  had  incontinence  of  urine,  pain  in  the  loins  and  perine- 
um, and  whenever  the  urine  was  difcharged  by  voluntary 
exertions,  it  was  in  drops  and  with  violent  {training.  The 
Stricture  was  fituate  three  and  a  half  inches  from  the  ex- 
tremity of  the  urethra.  He  had  been  affected  with  gonor- 
rhoea five  or  fix  times.  In  March,  1813,  he  began  to  expe- 
rience difficulty  in  paffing  his  urine,  which  was  difcharged 
in  a  fmall  ftream,  whilft  his  calls  to  pafs  it  were  very  fre- 
quent. His  difeafe  was  alfo  attended  with  an  ague  and  fe- 
ver, as  he  termed  it.  Sometime  in  the  following  autumn  he 
loft  the  power  of  retaining  his  urine  altogether.  After  his 
admiffion,  the  common  bougie  was  directed.  This  inftru- 
ment  was  employed  about  a  fortnight,  without  any  benefit. 
The  cauftic  was  then  directed  to  be  applied,  and  after  three 
applications  he  was  enabled  to  retain  his  urine  for  a  fhort 
time,  and  paned  it  in  a  fmall  ftream.  By  the  19th  of  March5 
one  inch  had  been  gained  on  the  Stricture  ;  his  complaints 
much  as  before.  In  April  the  principal  Stricture  was  pafTed  ; 
but  another  prefented  at  about  fix  inches  from  the  extremi- 
ty of  the  canal.  The  common  bougie  was  employed  to  over- 
come this  obftruction.  On  the  4th  of  May  the  patient  had 
fuppreffion  of  urine,  which  continued  about  twenty-four 
hours,  but  which  yielded  to  the  ufe  of  anodynes,  warm  bath 
and  the  bougie.  Two  days  afterwards,  a  fmall  inftrumem 
was  introduced  into  the  bladder,  with  but  little  difficulty. 


4* 

The  irritation  in  the  urethra,  however,  became  fo  great,  that 
it  required  the  ufe  of  the  bougie  to  be  fufpended  till  the  *8th. 
On  the  20th  a  pretty  large  bougie  was  pafled  into  the  blad- 
der. The  patient  was  difcharged  from  the  houfe  on  the 
ioth  of  Jure. 

Cafe  of  Striclure  with  mortification  of  the  fcrotum  y  in  confequence 
of  the  effufion  of  urine. 

W m  H s,  a  coloured  man,  born  in  Maflachufetts, 

aged  about  50  years,  was  admitted  into  the  New- York  hot* 
pital  June  3d,  18 14.  The  patient  had  Stricture  fituate  about 
feven  inches  from  the  external  orifice.  He  had  been  twice 
affected  with  clap,  had  experienced  difficulty  in  pafling  his 
urine  twelve  years,  and  had  been  under  furgical  treatment. 
♦Two  or  three  days  previous  to  his  admiflion,  he  had  more 
than  ufual  difficulty  in  paffing  his  urine,  to  relieve  which  he 
employed  a  bougie  himfelf,  but  did  not  fucceed  in  getting  it 
into  the  bladder.  The  application  of  the  inftrument  was 
made  with  fuch  violence  as  to  give  great  pain,  and  was  fol- 
lowed by  hemorrhage.  After  its  introduction  there  was  a 
total  fupprefSon  of  urine,  and  after  draining  violently  to 
evacuate  the  bladder,  the  cellular  membrane  of  the  fcrotum 
perineum,  &c.  became  much  diftended  with  urine,  in  which 
{late  it  was  at  the  time  of  his  admiflion.  The  patient  had 
great  pain  in  the  parts,  with  forenefs  to  the  touch.  The  ab° 
domen  likewife  was  tenfe  and  painful  on  being  prefled,  and 
he  had  general  febrile  fymptoms.  The  urine,  at  this  time 
was  difcharged  by  drops,  by  violent  exertions.  After  his 
admiflion  the  fcrotum  was  freely  punctured  with  a  lance^ 
by  which  means  a  very  confiderable  quantity  of  urine  was 
difcharged  from  the  cellular  membrane.  A  fpirituous  lotion 
was  directed  to  be  applied  to  the  part,  and  the  bowels  open- 
ed by  an  enema.  After  this,  a  fmall  bougie  was  pafled  through 
the  Stricture,  which  had  the  effect  of  producing  a  pretty 
F 


42 

free  flow  of  urine.  Three  or  four  days  after  his  admiffioi^ 
an  extenfive  mortification  of  the  fcrotum  took  place.  He 
was  then  put  on  the  ufe  of  bark,  wine  and  a  nutritious  diet, 
and  had  the  uiual  local  applications  to  the  mortified  part. 
The  bougie  was  at  the  fame  time  ufed  daily,  to  keep  the  ure- 
thra pervious.  On  the  15  th  of  July,  the  fcrotum  was  com- 
pletely healed,  and  he  was  able  at  that  time  to  difcharge  his 
urine  in  a  full  ftream.  On  the  8th  of  Auguft  he  was  dif- 
charged  from  the  houfe. 

Cafes  of  Stri&ure  in  ivhich  the  bougie  armed  with  the  caufiic  fo- 
lutiotiy  nvas  employed. 

It  may  be  proper  to  premife,  that  in  the  following  cafes 
the  cauftic  employed  was  formed  of  equal  parts  of  the  corro- 
five  muriate  of  mercury,  muriate  of  ammonia  and  water. 

The  author  has  had  an  opportunity  of  obferving  the  ef- 
fects of  a  folution  of  the  nitrate  of  filver  and  of  the  corrofive 
fublimate,  and  can  fpeak  confidently  of  their  efficacy  ;  but 
as  has  been  before  obferved,  the  folution  of  the  triple  fait  of 
muriate  of  mercury  and  ammonia,  is  preferred. 

N m  O d,  born  in  Canada,  aged  3  2  years,  car- 
penter, was  admitted  March  8th,  1814.  At  the  time  of  his 
admiffion  he  had  incontinence  of  urine,  complained  of  pain 
in  the  back  and  loins  ;  general  health  unimpaired.  On  in- 
troducing a  bougie  into  the  urethra,  it  was  (topped  by  a 
ftricture  three  inches  from  the  orifice,  which  could  not  be 
paSed  by  the  fmalleft  inftrument.  He  had  been  affected 
with  gonorrhoea  four  of  five  times.  The  laft  time  he  had 
the  difeafe,  it  was  followed  by  a  dark  coloured  tumour  on 
the  dorfum  of  the  penis,  which  fuppurated,  and  was  opened 
with  a  lancet.  He  began  to  experience  difficulty  in  difcharg- 
ing  his  urine,  immediately  after  the  ulcer  on  his  penis  heal- 
ed j  and  the  power  of  retaining  it  was  loft  about  two  and  a 
half  years  before  his  admiffiorh     On  the  10th  of  March,  the 


4$ 

common  armed  bougie  was  introduced,  and  applied  about 
half  a  minute.  The  application  was  attended  with  confider- 
able  pain,  and  was  followed  by  a  fuppreffion  of  urine  and 
diftention  of  the  abdomen.  He  took  a  large  anodyne  at  a 
late  hour  in  the  night,  without  any  relief  in  his  Symptoms, 
and  from  his  violent  efforts  to  relieve  the  bladder  the  urine 
became  effufed  into  the  cellular  fubftance  of  the  prepuce. 
This  was  freely  punctured  to  permit  the  efcape  of  the  effu- 
fed urine,  and  a  fmail  fized  bougie  was  paffed  into  the  Stric- 
ture, and  permitted  to  remain.  In  a  few  minutes  the  inftru- 
ment was  withdrawn,  and  the  urine  was  afterwards  difcharg- 
ed  with  tolerable  freedom.  Preventive  means  having  been 
employed,  no  material  inflammation  of  the  penis  fupervened. 
The  cauftic  was  again  applied  feveral  times  in  the  courfe  of 
the  month,  and  the  firft  Stricture  was  overcome.  After  this 
the  common  bougie  was  employed  to  overcome  a  Stricture 
of  very  great  firmnefs.  This  inftrument  was  exchanged  on 
the  8th  of  May,  for  the  bougie  dipped  in  the  cauftic  Solu- 
tion. A  confiderable  quantity  of  ftringy  matter  was  dis- 
charged with  the  urine,  after  the  ufe  of  it.  By  the  20th, 
after  repeated  applications  of  the  bougie  dipped  in  the  cauftic 
folution,  an  inftrument  could  be  paffed  two  and  a  half  inches 
further.  The  ufe  of  this  cauftic  was  continued  till  the  30th, 
at  which  time  a  bougie  could  be  paffed  within  a  fhort  dis- 
tance of  the  bladder.  On  the  2d  of  June,  a  common  bou- 
gie of  confiderable  fize  was  introduced  into  the  bladder. 
This  inftrument  was  ufed  till  the  14th  of  June,  at  which 
time  he  was  difcharged. 

R d  H— n,  born  in  New- York,  aged  28  years,  Sea« 

man,  was  admitted  July  8th,  18 14,  with  gonorrhoea  and 
Stricture.  The  patient  had  not  been  free  from  clap  in  eight 
months.  He  had  been  affected  with  the  diSeaSe  five  differ- 
ent times  and  had  experienced  difficulty  in  discharging  urine 
three  months.     At  th-  time  of  his  admiffion  he  paffed  urine 


44 
by  drops,  and  occaiionaily  in  a  fmall  ftream.     He  complain- 
ed of  pain  in  the  loins,  and  a  fenfe  of  weaknefs  and  forenefs 
of  the  perinseum.     The  ufual  remedies  for  gonorrhoea  were 
firft  employed,  and  after  the  fymptoms  of  this  difeafe  were 
fubdued,  the  common  bougie  was  reforted  to.     By  the  ap- 
plication of  this  inftrument,  five  different  Stri&ures  were 
PaiTed.     Another  one  obftructed  the  paffage  at  feven  inches 
from  the  extremity  of  the  penis.     The  common  bougie  was 
ufed  twenty  days  to  overcome  this  obftruction,  without  ef- 
fect.    The  bougie  armed  with  the  cauftic  folution  was  then 
employed,  and  after  two  applications  the  Stricture  was  over- 
come.    The  common  bougie  was  again  employed  for  two 
weeks  and  the  patient  was  difcharged  on  the  14th  of  Sep- 
tember. 

H h  L !~h,  a  patient  labouring  under  difeafed  liver 

and  dropfy,  had  alfo  Stricture  of  the  urethra.  The  latter 
affection  caufed  much  inconvenience.  He  had  frequent  and 
urgent  calls  to  make  water,  and  was  generally  out  of  bed  eve- 
ry half  hour  for  this  purpofe.  His  urine  paffed  by  drops  for 
the  moft  part,  but  at  times  in  a  very  fmall  ftream.  The 
bougie  was  interrupted  in  its  courfe,  four  inches  from  the 
extremity  of  the  urethra,  by  a  Stricture.  This  was  paffed 
by  the  bougie  \  but  another  obftructed  its  further  progrefs 
at  feven  inches.  An  attempt  was  made  to  pafs  this  alfo,  by 
a  fmall  fized  inftrument,  but  without  fuccefs.  The  bougie 
armed  with  the  cauftic  folution  was  then  ufed,  and  on  the 
fecond  application  the  Stricture  was  paffed.  Confiderable 
hemorrhage  followed,  but  the  patient  experienced  very  great 
relief  immediately  afterwards,  and  was  able  to  pafs  his  urine 
with  much  freedom.  After  the  irritation  confequent  to  the 
ufe  of  the  cauftic  had  fublided,  a  catheter  of  moderate  fize 
was  introduced  into  the  bladder, 


45 

M b  B a,  a  native  of  France,  aged  20  years,  mar- 
iner, was  received  from  the  medical  department  of  the  houfe 
April  14th,  1814.  He  had  a  firm  Stricture  fituate  two  and 
3  half  inches  from  the  orifice  of  the  urethra.  Cmplained  of 
pain  and  weakneis  in  the  fmall  of  the  back,  He  had  expe- 
rienced difficulty  in  paffing  his  urine  five  or  fix  years,  and 
had  been  twice  affected  with  gonorrhoea.  His  urine  was  dis- 
charged by  drops,  and  at  times  in  a  very  fmall  ftream.  The 
common  bougie  was  employed  for  a  confiderable  length  of 
timeVithout  material  benefit.  In  May  the  bougie  dipped  in 
the  cauftic  folution  was  employed  a  number  of  times,  with 
the  moft  decided  advantage.  Three  Strictures  were  in  fuc- 
ceffion  encountered  and  pafled.  On  the  firft  of  June  the 
bougie  could  be  introduced  fix  incHpc,  »»<*  <>n  the  2  2d  of  the 
fame  montk  cmotkc*  very  confiderable  Stricture  was  over- 
come by  the  above  mentioned  inftrument.  In  September  a 
large  fiiver  catheter  could  be  pafled  very  readily  into  the 
bladder. 

W -m  W bb,  born  in  Salem,  Maflachufetts,  aged 

42  years,  feaman,  was  admitted  1 6th  of  Auguft,  18 14,  with 
fyphiiis  and  a  firm  Stricture  juft  at  the  extremity  of  the 
urethra. 

He  had,  according  to  his  own  account,  been  affected  with 
the  venereal  difeafe  above  thirty  times,  and  the  glans  penis 
had  been  deftroyed  by  previous  chancre.  He  had  experienc- 
ed no  very  material  inconvenience  in  paffing  urine,  till  a  few 
days  previous  to  his  admiliion. 

After  his  chancres  had  healed,  a  very  fmall  bougie,  arm- 
ed with  the  cauftic  folution,  was  pafled  into  the  Stricture. 
The  application  of  the  cauftic  was  feveral  times  repeated, 
till  the  paflage  of  a  moderate  fized  bougie  could  be  admitted. 
Two  Strictures  were  afterwards  encountered  and  overcome 
by  this  inilrument. 


4 

The  patient  was  detained  in  the  houfe  -titl  the  2  2d  of 
November,  on  account  of  an  inflamed  eye.  At  this  time 
he  difcharged  his  urine  with  freedom. 

-W- — — m  B- h,  born  in  Connecticut,  aged  27  years, 

feaman,  was  admitted  on  the  6th  of  September,  with  rheu- 
matifm  and  Stricture  of  the  urethra.  He  had  experienced 
difficulty  in  paffing  urine  about  four  months.  Previous  to 
this  period  he  had  been  affected  with  fyphilis.  A  very  foul 
chancre  behind  the  corona  glandis  fo  completely  deftroyed 
the  parts,  as  to  make  an  opening  quite  through  into  the 
urethra,  and  the  urine  was  difcharged  by  this  opening,  as 
well  as  by  the  natural  paffage,  for  a  fhort  time.  The  pa- 
tient had  been  affected  four  or  five  times  with  gonorrhoea. 
When  he  was  admit  tod,  *He  urine  was  paffed  with  much 
difficulty  in  drops,  or  in  a  fmall  inccn  uptcd  ftream. 

There  was  a  firm  Stricture  in  a  fituation  correfponding 
with  the  corona  gtandis,  in  the  courfe  of  the  urethra,  which 
could  not  be  paffed  by  the  fmaileft  bougie.  For  this  reafon 
an  inftrument  armed  with  the  cauftic  folution  was  had  re- 
courfe  to,  and  on  the  third  application  the  Stricture  was 
paffed.  It  was  afterwards  applied  twice,  by  which  means  a 
moderate  fized  bougie  could  be  admitted  into  the  canal. 

Three  Strictures  were  afterwards  met  with  in  the  courfe 
of  the  urethra,  which  readily  yielded  to  the  common  bougie. 
The  patient  was  difcharged  from  the  hofpital  on  the  29th 
of  November,  cured  of  both  difeafes. 


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